ENROL NOW

We are required by our funding body to include the following information in our statistical returns to the Federal Government. Information is treated as strictly confidential at all times.

You may be surveyed at a later date to help the government determine your level of satisfaction with the service you received.

No personal information from data collection is used for any other purpose except as required by law.

Victorian Student Number

I do not know my Victorian Student Number but I have attended a Victorian school, TAFE or other Training Provider.

Are you new to the Victorian Education System?

I have never attended a Victorian school, TAFE or other Training Provider.

Date Of Birth:

Gender:

M

F

Are you of Aboriginal or Torres Strait Islander Origin:

yes

no

Employment Category (please tick one)

Full Time Paid Employee

Part Time Paid Employee

Self Employed – Not employing Others

Employer

Employed – Unpaid Family Worker

Unemployed – Seeking Full Time Work

Unemployed – Seeking Part Time Work

Not Employed – Not Seeking Paid Work

Country of Birth

Language Spoken at Home:

If you speak a language other than English at home, how well do you speak English?

Very Well

Well

Not Well

Not at All

What is your Highest Completed School Level:

Year 7

Year 8

Year 9

Year 10

Year 11

Year 12

Special School

Did not attend School

Which Year did you complete that level of school?

Are You still Attending School?

yes

no

Have you completed any Further Education? (please tick)

Batchelor Degree or Post Graduate Qual.

Advanced Diploma or Assoc Degree

Diploma

Certificate 4

Certificate 3 or Trade Certificate

Certificate 2

Certificate 1

Miscellaneous

What is your reason for enrolling in this course? (please Tick)

For personal interest

I wanted extra skills for my job

it was a requirement of my job

to start my own business

to develop my existing business

to get into another course of study

to get a better job or promotion

to try for a different career

for self development

Do you consider yourself to have a disability, impairment or long term condition?

yes

no

If YES, please tick which area/s of disability, impairment or long term condition:

Hearing/ Deaf

Medical Condition

Vision

Intellectual

Physical

Other

Acquired Brain Impairment

Mental Illness

Is there anything we can do to support your participation in this class? (eg notes in Large Print etc)

May we pass this information on to the tutor, to be used in an emergency

yes

no

Are You an Australian Citizen?

yes

no

*If NO Are you a Permanent Resident of Australia?

yes

no

Do you have a Temporary Protection Visa?

yes

no

If You have answered No to all of the above questions you are not eligible for a Government Funded place.

Do you hold any of the following Concession cards?

Commonwealth Health Care Card

Pensioner Concession

Veteran’s gold card

yes

Card Number:

Signature:

Expiry Date:

Date:

PLEASE ENSURE ALL DETAILS ARE COMPLETED

“Amazing community resource with the best of people leading the way”. - Merryn Auldist

“Wow! What an amazing new site. We can’t wait to use the stunning meeting rooms for our next “Sharing Stories” workshop.” – Lisa, Hatrick Communications

“Just called in to see what its all about and two hours later we left! Amazing staff so friendly, great atmosphere. I’ll be back”. - Dorothy Reid Ridley

“Awesome team” - Linda Steane-Hancock

“Thank you Japara Neighbourhood House. What a fantastic venue. The staff are so helpful and friendly. The facilities resources are amazing. Our function was a huge success and the venue just made it so easy. What a great community resource. Again thank you”. Michael.